Did Mark Madoff have PTSD?

If you go from brittle to fragile following a horrendous trauma, the fear of being re-traumatized and going from fragile to shattered, fragmented and irretrievably lost can drive a person who needs to be in control to take desperate actions… including killing themselves.

It would be improper and inappropriate for me to diagnose Mark Madoff without having met and evaluated him. However having been a clinical psychiatrist who has met with and treated desperate, suicidal and violent people for over thirty years, there are a number of factors known to the public about Mark Madoff that have caused me to conjecture that undiagnosed and untreated PTSD might have contributed to his committing suicide.

Central to a diagnosis of PTSD is that there has been a severe psychological trauma whose effects are more lasting than what is referred to as an acute stress response.

In my capacity as someone who tries to listen deeply and get where people are coming from their inside out (vs. plugging them into a diagnosis via checklists that I apply from their outside in), here is the process that occurs in previously tough and strong people who I have later diagnosed as having PTSD:

1. Feeling Bulletproof – Prior to the trauma, they often felt invulnerable as if nothing could harm them (the way a very wealthy person who can buy anything – and sometimes anyone –can feel all the way to a freshly trained soldier before they enter battle).

2. Horrendous Trauma – There is usually something horrific about the trauma. Horror has a way of destabilizing the acting, feeling and thinking parts of their brains so they can no longer work together. This may explain the use of the expressions: “Wigged out,” “Coming unglued,” “At wit’s end.”

3. Raw Vulnerability – As bulletproof as they once thought they were is as vulnerable as they have turned out to be. There is a belief that they don’t know how they survived the first trauma and an unconscious belief that they wouldn’t survive being re-traumatized. One of the reasons for “anniversary reactions” (such as Mark Madoff may have been having on the 2nd anniversary of Bernie Madoff’s arrest, that Mark and his brother, Andrew, were instrumental in).

4. Brittleness – Not being able to find peace outside or inside their life or inside their psyche, leads to a brittleness where anything can set them off. This leads to the heightened startle respond common to people with PTSD.

5. Terror – Inside there is a deeply held belief that any re-traumatization will cause them to shatter and fragment and there is a feeling of impending inevitability that it will happen which creates a state of terror, difficulty sleeping, heavy self-medication (which also dulls ones rational thinking).

6. PTSD Symptoms – Most of the symptoms of PTSD from withdrawing to alcohol and substance abuse to not sleeping (since the experience of and fear of nightmares adds to the terror) are attempts to avoid re-traumatization.

7. Fragility – Feeling on the brink of going from brittle to shattering, fragmenting, losing their mind and never getting it back can cause a person who needs to be in control to take desperate measures including killing themselves. That is because to such a person, losing complete control is a fate worse than death.

Now of course this all begs the question, how do you treat this?

Here’s the rub. Unless someone goes back to the original trauma and reprocesses and fully processes all their emotional and psychological reactions and their aftermath, they will be in a state of psychological limbo and purgatory. If they re-experience their feelings they think you’ll shatter/fragment; if they don’t re-experience and feel them through (“Having Horror Heard Helps Heal Hurt”) they will never strengthen their core vulnerability and you will develop increasing phobias and avoidance because it feels as if more and more things can re-traumatize and break you.

The simple answer is learning to safely re-experiencing their unfelt feelings and re-experiencing them until they build emotional strength and resilience from the inside out so that they can “take the hits” from life from the outside in and bounce back.

As you can imagine, the answer may be simple, but it is not easy because of the fear that re-experiencing a trauma will re-traumatize and break them.

Getting traumatized people to reach out for help and then accept and commit to it will be the subject of a future blog.